HPC Report: Question 1 Costly, Harms Access, Won’t Improve Care

The state’s Health Policy Commission released its independent, unbiased study of how mandated nurse-to patient staffing ratios contained in ballot Question 1 would affect the Massachusetts healthcare system, and found that Question 1 would cost the state up to $949 million annually, would most likely result in “no systematic improvement in patient outcomes,” and would adversely affect community hospitals serving a high proportion of MassHealth and Medicare patients.

The HPC’s $949 million upper cost estimate does not include the cost associated with emergency departments (which require four different ratios under Question 1), or costs relating to outpatient departments, observation units, all non-acute hospitals, as well as state agency implementation costs and penalties for non-compliance.

The $949 million estimate is similar to the figure that Mass Insight and BW Research Partnership arrived at through their research, but is $900 million more than the MNA’s much-derided estimate of $47 million annually.

“This is an absolutely terrifying day for healthcare in our state,” said Dan Cence, spokesperson for the Coalition to Protect Patient Safety. “The Health Policy Commission’s analysis confirms that the negative consequences are too great and the costs are too high for rigid, government-mandated nurse staffing ratios in the commonwealth. This puts the cost question to bed.”

The HPC’s research was conducted by the commission’s Research Director Dr. David Auerbach and by University of California San Francisco Professor Dr. Joanne Spetz.

The researchers found that the only other state with mandated ratios – California – imposed a markedly “less strict” mandate on its hospitals than is proposed in Massachusetts. California had five years to implement the law (as opposed to 37 days in Massachusetts), allows a 1:5 ratio on Med/Surg floors (1:4 in Mass.), and allows waivers for dozens of rural hospitals (no waivers are permitted under Question 1). Also there are no non-compliance penalties in California, but in Massachusetts hospitals would have to pay up to $25,000 per day, per incident for violating the rigid and arbitrary ratios.

But the main – and most important – difference between California and Massachusetts is that Bay State hospitals deliver better care to patients and that in California “there was no systematic improvement in patient outcomes post-implementation of ratios,” according to the HPC.

The HPC concluded, “If the proposed initiative becomes law, the increased costs to hospitals may result in impacts such as:
•Reductions in hospital margins or assets
•Reduced capital investments
•Closure of unprofitable (and/or other) service lines
•Reductions in non-health care workforce staffing levels.
“These costs could also lead to higher commercial prices for hospital care, potentially leading to higher premiums.”

“The HPC’s findings reaffirm multiple warnings about the true costs Question 1 would force on patients, their families, insurers and healthcare providers,” said Steve Walsh, MHA president & CEO. “In particular, it asserts the increased costs for high public-payer hospitals – serving some of the commonwealth’s most challenged communities – would be most affected, with the possibility of devastating effects to patient access to care. With regard to emergency departments, the HPC also finds the potential for ‘significant impacts’ on access to emergency care, wait times, patient flow, emergency room boarding, and ambulance diversion. Though the supporters of Question 1 have dismissed these concerns as ‘scare tactics,’ the HPC recognizes that these are very real threats to patients in our communities. Every hospital in Massachusetts opposes Question 1. That’s why we are part of the Coalition to Protect Patient Safety. This coalition includes more than 100 healthcare organizations and is striving to put daylight on the troubling consequences this ballot question poses to patients and communities throughout the state. Today’s report by the HPC further reinforces the harm Question 1 poses and provides additional evidence as to why voters should say ‘No’ to Question 1 on November 6.”